HomeMy Public PortalAbout9632 LONGDEN AVE_Sewer__ 9BA $
r•BR66B APPLICATION FOR PERMIT`
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DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL
Depcutment of County Engineer
County of Los Angeles 3UILDING .-
JOHN A. LAMBIE, COUNTY ENGINEER _ADDRESS
CASSATT D, GRIFFIN SUIT of RU110iNG
OCALITY - �'- —•----- -
_ FOR APPLICANT TO FILL IN ROSS T
E,T,
LEGAL i,ROSS
DESCRIPTION LOT 01.° '! WNcR - :I 72 ,C
— ---- —
BLOCK / 'TRACT
/ -- ! .DDR.;S k=fir— ,, ,' v, ' .�✓
NO. OF BLDG.S.
SIZE OF LO'T: �� ry",yNDW ON L01 t-' EL, N0.
USE OF
BUS1.DiNGS �' • '. �'RICT rd0: I GROUP 1 MAP
BK PG
CONTRACTOR > _ ✓
ADDRESS ' CONNECTION DATA
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..-----^� / STATION °` s // DEPTH J
CITY TEL. NO. .iyr 7 y,! --- -
i4ANHQLE REFERS CE -- -- -�-e ,;
--:y 51
,.'STATE I COINER t.
REGISTRATION NO.. _:. ❑ COUNTY -- - ---
NO, i DESCRIPTION OF WORK FEE ------ ---------------------------_.— _�.-_`.
-} - -- ---- -...-- -- - -- --- `-- TYPE 1 • 0F,Ck" EC7IONLENGTH
LEN TH FROMHOUSE SEWER CONNECTING TO T•$ _ URB- -P L. M.L,TO P,L. ..
3
-
PU641C SEWER
>--.----
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINF.fELD (iP- $3.00
j OVERFLOW SEEPAGE PIT.DRAINFIELD P. C. NO•
--- j r.XTN:,.CEaSP00L,DRYWELL,MANHOLE C& $2.00 0. IMP. N0. JOB N0,
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM. cti $1.00 ! f ''RUNK PERMIT NO. ROAD PERMIT NO,,C `i"
CONNECT ADDITIONAL BLDG OR -----
RK TO USE ER (� STATE ENCROACHMENT
J- 440HO5ESEWER5.i.00 IJ 11 ERMIT N0.
ALTER,REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM f I $7.00 NpUSTRSAt
_..�. _-- _-- - - _-- -� WASTE APPROVAL
CHARGES
I --
._-,_ CONNECTION CHARGE FEE
i
OWNER'S PERMIT _ - ----� -
_ _ 00
f-.<.�.. REIMBURSEMENT FEE - -
AUTHORIZATION TOTAL FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON.
APPROVALS DATE iNSP-CTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. is _ NEW HOUSE SEWER
----------
SIGNE➢THIS ���OF =�=� 6NNEC7 ADDITIONAL I
OWNER OR ' '� BUILDING OR WORK _
OWNERS AGENT •� ._ ----- --- -`--�--- --._----
SEPTIC TANK,SEEP.PIT(S) i
ADDRESS—vy ' ' p ... �P -'° AND/CR DRAI.NF ELD I
I HEREBY ACKNOWLEDGE THAT 1 .HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLYWITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEiNERS• _SEWAGE DISPOSAL SYSTEM —.�..-------
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND I `�
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER I_—
CALIFORNIA OR THAT I— M THE LEGAL OWNER OF THE ABOVE -- ---- --- — _I
DESCRIBED RESIDENTI P OPERTYg - BACKFILL SEPTIC TANKS rl
SIGNATUREJ SEEP.PIT(S),J CESSPOOLS C
CF PERMITTEE
IOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A. WOOE).CHIEF PLEIG. INSPECTOR
CK. Id. ®, $ASN
76A 642D-CE808 A-7J76 APPLICATI� N FOR PE MIT
SEWER—SEWAGE DISPOSAL
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN DISTRICT N�OJ. GROUP BK MAP yPa TR SSED BY
BUILDING /Y "y 73
ADDRESS �. � 'f'M'i. (yt✓' n
y�,.�,✓ ' CONNECTION-DATA
LOCALITY' �/i ....y
NEAREST STATION DEPTH //
CROSS ST.
l �ry MANHOLE REFERENCE / � - LOWER
OWNETYPE OF�C.p.N 4 I?N / LENGTH FROM
MAIL / _�
ADDRESS �{/ /�}��,i. Y' �CUIj$..- p.L. M.L.TO P.l.
�5..� P.C.NO.
CITY °TSL. NO. L. �. CO.IMP.NO. /_33 Z-- JOB NO.
LEGAL TRUNK PERMIT NO. ROAD PERMIT NO,
O ESCRIPTION LCT NO.
�- AFFIDAVIT wAlv[le [A5[M[x1' RECORD.INSTR.NO, I DATE
BLOCK TRACT(�,�
NO. OF BLDG5. �-
SIZE OF LOT NOW ON LOT HWY.OR ST.WIDENING _'7"x'1-'�'-"v�' I USE OF STATE ENCROACHMENT '
BUILDINGS PERMIT NO.
-- INDUSTRItL_,_. _--
CONTRACTOR _ ASTE APPROVAL a
ADDRESS
CHARGES Q
CONNECTION CHARGE FEE
CITY TEL. NO. �.
STATE LIC REIMBURSEMENT FEE 0
LICENSE NO. CLASS _
NO. DESCRIPTION OF WORK FEE APPROVALS DATE INSPECTOR'S SIGNATURE W
HOUSE SEWER CONNECTING TO 0.
PUBLIC SEWER V)
SEPTIC TANK,SEEPAGE PIT OR NEW HOUSE SEWER _ Z
PITS AND/OR DRAINFIELD @ CONNECTADDITIONAL p
HOUSE SEWER CONNECTING TO BUILDING OR WORK
PRIVATE DISPOSAL SYS�TEdL--. I _ SEPTIC TANK;SEEP,PIT(S) I
/ CONNECT ADDITIONAL B'CLC'OR - AND/OR DRAINFIELD
o
W6if.&Q_HOUSE SEW
OVERFLOW SEEPAGE PIT.DRAINFIELD CE55POOL [3OR-YWELL ❑
E XT N.,CESSPOOL.ORYWELL.MANHOLE( -
ALTER,REPAIR OR ABANDON HOUSE ALTER,REPAIR.SEWER OR
SEWER OR DISPOSAL SYSTEM SEWAGE DISPOSAL SYSTEM
DISCONNECT PLUG AND
ABANDON HOUSE SEWER
BACKFILL SEPTIC TANKS ❑
SEEP.PIT IS) ❑ CESSPOOLS ❑
OWNER'S Issuance Fee Sim
_ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AUTHORIZATION TOTAL FEE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- PLUMBING AND SEWERS.
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
TO THE PUBLIC SEWER. LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF
SIGNED THIS DAY OF _19_ CALIFORNIA OR THAT i AM THE LEGAL OWNER OF, AND I ND TO
OWNER OR RESIDE IN, THE ABO VfE�EJ.}7�R#ED��RESI DENTIAL OP .y7
OWNERS AGENT _ SIGNATURE f/ ✓ 'i_ Y V Yr'
OF PER MTTTEE ,�j, � �
ADDRESS
VALIDATION
cc K- M.O. CASH